28D2230900 CLIA NUMBER - WALGREENS #04772

Laboratory Demographics

  • CLIA Code: 28D2230900
  • Facility Name: WALGREENS #04772
  • Facility Address: 3005 LAKE ST
    OMAHA, NE
    ZIP 68111
  • Facility Phone: 402 451-7201
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: EDMUND W. WONG
  • NPI Number: 1093722027
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 28D2230900
LAB Type Pharmacy
Facility Name WALGREENS #04772
Street 3005 LAKE ST
City OMAHA
State NE
ZIP 68111
Phone 402 451-7201
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/28/2025
Certificate Expiration Date 7/27/2027
Facility Type Pharmacy
Lab Director EDMUND W. WONG

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This page was last updated on: 9/29/2025